Saturday, January 30, 2016

Cristal-Net - Quebec's Province Wide EMR Solution

C'etait tres interesant pour moi d'apprend que "Cristal-Net" devoir la seule EHR dans la province de Quebec! La seule! It started as a home grown system at the University of Laval and their affiliated hospital. I think they also had help from a programming group from France. Makes a lot of sense to have french language programmers. I am all in favour of home grown systems.

It is remarkable that the Province of Quebec government was able to pass legislation making this Hospital EHR system the only one that will be used in all the hospitals in the province! How is that possible? This is a very interesting story, one that could probably never be played out in Ontario. I remember a few years back after an eHealth Ontario scandal when the McMaster OSCAR EMR was being offered as an open source solution for healthcare records at vastly lower costs.  Of course, business and project management interests seem to drive the EHR solution in Ontario more than the government regulated healthcare system. Quebec definitely has a different culture! Smaller countries like Denmark where able to achieve 100% EHR integration for all their citizens very early. By culture I mean "the way of doing things".

"Québec) Le gouvernement Couillard a finalement décidé qu'une seule solution informatique, Cristal-Net, sera déployée dans l'ensemble du territoire québécois pour la mise en oeuvre des fameux dossiers cliniques informatisés (DCI). Une nouvelle qui réjouit le directeur des technologies de l'information du CHU de Québec-Université Laval, Jean Boulanger, qui a permis à son établissement d'obtenir l'entièreté des droits de propriété intellectuelle du logiciel pour la province."

The story in English is best read here:
"QUEBEC CITY – Health Minister Gaétan Barrette (pictured) announced that Quebec will move toward the use of a single electronic health record system in hospitals across the province. The solution decided upon by the province is called Cristal-Net, and it has been in use at the Centre hospitalier universitaire de Québec – Université Laval since 2003.
“The decision to deploy a single solution for Electronic Medical Record is part of our efforts to standardize practices within our health and social services, clinically and financially and administratively,” said Barrette. “This will benefit clinicians and all users.”

Thursday, January 7, 2016

Adopting Patient Portals

Interesting article on why patient portals have not caught on yet:

Unlocking the value of patient portals: 3 thoughts from athenahealth

Patient portals are meant to conveniently connect patients and providers, but adoption of these tools lags despite a mounting demand from patients for this very capability.


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Tuesday, December 22, 2015

Kaiser Survey Links Portal Use With Improved Perceptions of Health | Healthcare Informatics Magazine | Health IT | Information Technology

Kaiser Survey Links Portal Use With Improved Perceptions of Health | Healthcare Informatics Magazine | Health IT | Information Technology

I posted this link automatically after the story turned up in my google search RSS feed. The website with this Kaiser Survey story had over 280 reference (or Add This ) RSS icon links for sharing the story. I often share stories to my Twitter feed which also has an eHealth theme. My Facebook feed is mostly for personal stories. I can remember before Facebook when RSS was just developing, what a liberation it was from the inbox. Some email programs had a way to receive RSS feeds into a local folder or there was a browser navigation item where one could store the RSS links, kind of like bookmarks. These days I am told that the younger kids don't even read email - they are just message chatting on their smartphones or other social media sites. I still think RSS - Real Simple Syndication - is the greatest technological invention since newspaper publishing. In fact, I have "health informatics" set in a google search feed, which is just an RSS program.

RSS is programmed in XML. I took a course in XML once and started creating my own RSS feeds on the websites I had created. It was not that difficult. XML is also the basis for the HL7 standard for health records and interoperability. It is too bad that more personalized RSS "news" doesn't come into our google or other email accounts in terms of our own personal health records. I personally don't see the interoperable difficulty in doing that. Add to that developments in "web services", API, and inter-database sharing platforms like REST, and there are a lot of open doors for data sharing.

This eHealth enabled browser blog is dedicated to eHealth. Personal health records are a major interest that I like to share with others. After doing research for 5 years on PHR I still think they have many decades to go before they will be widely used. I could be mistaken here, but I just don't think the technology is ripe for wide spread PHR use. It is just not the technology, it is also the social awareness of health and wellness that is lacking.  Newer forms of technology might enable an evolution of this awareness - hard to say. A friend of mine who I follow on Facebook recalled the time in his university in 1990 when he and a colleague decide to get email accounts so they could stay in touch. They could not convince anyone else to use email because no one could see the reason for using a technology that no one else was using.

To get back to this story about the Kaiser Survey that showed that people thought that their health was improving because of using a PHR, I think that there is a need to find more evidence that PHRs can be a technological tool physicians may ultimately prescribe to help their patients. 

Saturday, December 19, 2015

Fall Prevention - From the Optimal Aging Portal

I volunteer with McMaster Family Medicine in the Tapestry program. We visit seniors who have volunteered to be in this research study. We bring an iPad and take a health survey. We also ask if they want to sign in to the McMaster Personal Health Record, which is integrated into the OSCAR EMR.  Many of the clients we have met have had falls.

Just saw this article on the McMaster Optimal Aging Portal about fall prevention. Because I have practiced Tai Chi for more several decades, and because I value the work of the Portal and the plain language systematic reviews and evidence based research they present to the public, I will post this here. It would be great if more people, both citizens and health professionals, could subscribe to the Portal.

Steady on your feet: New ways to improve balance and avoid falls

Dec 18, 2015
When it comes to keeping your feet safely on the ground – metaphorically and literally – it’s all about balance. But like many other things we take for granted when we’re young (strength, endurance, bone density, a full head of hair...) our sense of balance declines as we age. That’s one reason why older adults are at greater risk of falling and potentially becoming seriously hurt or even dying as a result (1).

Past research has shown that regular physical activity can help prevent falls, particularly when it includes exercises and movements designed to improve balance (2). Tai Chi for example, is recommended for its various benefits, including improving strength and balance through slow, controlled movements (3,4).

But if Tai Chi isn’t for you, there are other options you many want to consider. One recent systematic review of six studies measured the benefits of Pilates, a mind-body exercise program that has been popular since the early 20thcentury. Like Tai Chi, it involves controlled movements and concentrates on flexibility, strength, posture and breathing (5). Each study included older adult participants who took part in group Pilates sessions. The exercises varied (mat exercises as well as exercises using elastic bands, weights or other equipment), and included at least 2hrs of Pilates each week. The study participants were compared with a control group who kept up their usual daily activities but did not take Pilates.

Another emerging form of balance training that is gaining attention for its novel approach is “perturbation-based balance training” or balance recovery training. It focuses on improving people’s reaction time and helping them better recover from a loss of balance (6). Training can include equipment (such as moving platforms), or manual interference (such as nudges by a therapist) to enhance your ability to react and stop yourself from falling.

A recent systematic review of eight randomized controlled trials examined whether perturbation-based balance training lowers the risk for falls in older adults as well as people with neurological disorders such as Parkinson’s disease (6). More than 400 people between the ages of 50 and 98 took part in perturbation-based balance training and were compared with those in control group who participated in other types of balance enhancing exercises.

What the research tells us

Both Pilates and perturbation-based balance training appear to be promising strategies for helping older adults avoid falls and the resulting serious consequences.

Despite limitations in the quality of the Pilates studies the results suggest that Pilates is a promising way to help improve balance (5). So far the evidence on perturbation-based balance training is also encouraging: participants completing the training reported fewer falls and were less likely to fall, compared with those in the control groups (6). Further research is needed but there is cautious optimism that this approach may help people react and recover their balance more quickly so that a slip or trip doesn’t necessarily have to end in a fall.

Not sure which balance training exercises are best for you? Ask your doctor or physical therapist, or give these activities a try! At the same time, be aware of hazards and take the necessary precautions (e.g. good lighting, clear pathways, secure handrails etc.) so that you remain surefooted and safe as you enjoy an active lifestyle (7).

The Bottom Line

  • Older adults have a greater chance of falling and experiencing serious injury or even death.
  • Exercises aimed at improving balance have been shown to help prevent falls.
  • Initial studies of Pilates exercises (involving controlled movements to build flexibility, strength and posture) suggest it has the potential to improve balance.
  • Balance-recovery training aims to improve reaction time after a loss of balance and also appears to help lower risk of falls.
  • More high quality studies are needed to learn more about the benefits of Pilates and balance-recovery training.


  1. Centers for Disease Control and Prevention (CDC). Falls among older adults: an overview. [Internet] 2012. [cited Dec 2015] Available from:
  2. Gillespie LD, Robertson MC, Gillespie WJ et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012; 9:CD.007146.
  3. Mat S, Tan MP, Kamaruzzaman SB, et al. Physical therapies for improving balance and reducing falls risk in osteoarthritis of the knee: a systematic review. Age Ageing. 2015; 44:16-24.
  4. Leung DP, Chan CK, Tsang HW, et al. Tai chi as an intervention to improve balance and reduce falls in older adults: A systematic and meta-analytical review. Altern Ther Health Med. 2011; 17:40-48.
  5. Barker, AL, Bird M, Talevki J. Effects of Pilates exercise for improving balance in older adults: A systematic review with meta-analysis. Arch Phys Med Rehabil. 2015; 96:715-723.
  6. Mansfield A, Wong JS, Bryce J et al. Does perturbation-based balance training prevent falls? Systematic review and meta-analysis of preliminary randomized controlled trials. Phys Ther. 2015; 95:700-709.
  7. Public Health Agency of Canada (PHAC). You Can Prevent Falls. Ottawa, Canada. [Internet] 2011. [cited Dec 4, 2015] Available from: 


Optimal Aging Portal Blog Team

The latest scientific evidence on this topic was reviewed by the McMaster Optimal Aging team. Blog Posts are written by a professional writer, assessed for accuracy by Dr. Maureen Dobbins, an expert in interpreting and communicating the scientific literature, and edited by a professional editor. There are no conflicts of interest.

Wednesday, November 18, 2015

Interesting times for the visually impaired - technologically speaking!

These are interesting times for the visual impaired, technologically speaking at least. The number of advances in technologies for the eyes and the eye-brain interface, because a lot of the impairment is in our heads, has really started to amaze me, and they seem to be occurring every day. An idea to write a blog post on this has been brewing for sometime. This post was sparked by a story I read today about a little girl of seven years of age who was blind almost since birth because of a stroke and who was not allowed to carry her white cane (that is a technology too!)  to school. Not such an interesting time for her because it is a health and safety concern?

Also today I read about a bionic lens made by Ocumetrics that will return better than 20/20 vision by 3 times. That is in clinical trials but the promise is an 8 minute out patient "surgery". Just a couple of weeks ago I heard about a technology discovery that could replace our weak eye lenses with an LCD equivalent - liquid crystal sight - like having a smartphone camera lens implanted in our eyeballs and connected through the nervous system to the brain. That would really help, maybe even cure, older folks with presbyopia.

The idea that technology was rapidly moving ahead to aid the visually impaired occurred to me more than several years ago when I was made aware of a research study involving smartphones and the blind. In there was the idea that crowdsourcing could help the blind in a very simple way - especially those times when they were in a bit of a bind. All they have to do is use their smartphone to take a picture of the object of thing they can't identify, for example, a soup can, upload the picture to a crowdsourcing website, and wait for one of the minions who make working there a 24/7 enterprise. After a short wait in the kitchen they get a text to speech email spelling out for them the "tomato soup can" they wanted to open for lunch.

What if they could even eliminate the crowdfunding middle person? Yes, let's impoverish those already impoverished Mechanical Turks working for pennies again!  Why not just upload the image to a search engine that can identify images? It would have to be one customized to return a text to speech SMS. Then again we would have to trust in the artificial intelligence of the image recognition software. There is an ethical dilemma there, because that might not be a can of tomato soup for lunch! Another way to look at that is computer image recognition software that could read braille and translate it into text to speech? Google informs me via Wikipedia that that might be called "optical braille recognition". That idea occurred to me today when I saw a potentially new prothesis that can sense touch.

Of course, one of the great pioneers of all of this, Ray Kurzweil, was inspired to invent in order to help the visually impaired. He developed many text to speech products, like a Reading Machine that advanced Optical Character Recognition, Flatbed Scanners, and Text to Speech. One of his customers was the truly great though blind musician Stevie Wonder who got him into music apparently, and the Kurzweil synthesizers followed.

One of the most breath taking of the smartphone app devices to help the visually impaired is the KNFB reader. This is an app for a smartphone that allows the blind to pick up text off of virtually anything. This youtube video illustrates how it is used very well:

I have a personal interesting in the technology for visual impairments because I have amblyopia, or lazy eye. I have blogged a little about the video game intervention research that is so exciting as a novel and interesting way for kids to potentially fully regain vision in their lazy eye.  The game technology devices are getting more customized (sort of binocular suppression- see Hess, McGill University) as researches learn more about how the brain works. I have been in a clinical trial to see if adults can regain visual ability in the lazy. Not that much success for me but I am still keenly interested in it. I am especially interested given the fact that Transcranial Magnetic Stimulation in a certain area of the brain and at a certain frequency will restore perfect vision in adults with lazy eye, but only for 45 minutes! See, it is really all just in our heads! Eventually the bridge will be made there, I am hoping, without having to shock ourselves under that infinite loop coil of the TMS device more than several times a day.

There are a lot of other technologies for visual aids for professionals. There is an infrared visual smart glasses that let nurses see the veins in the arm better for intravenous needles. Google glass looks promising for some professional healthcare occupations, even in the surgery. Apparently Facebook is also working on ways to help the blind "see images".

Another smartphone development by a group called Peek Vision offers promising low cost diagnostic or comprehensive eye exam software on a smartphone. Needless to say, because it is mobil, remote villages in Kenya and elsewhere can now intercept patients with potentially serious eye or other health conditions:

I realize of course that I could keep adding to this list of new technologies, as I am doing now several months after posting. Since I got the TED app that has Chromecast, I found this talk by Chieko Asakawa from IBM, who is blind herself, on How Technology Helps Blind People Explore Our World:

What about a Kindle style braille ebook reader?

Thursday, October 22, 2015

myCARE patient portal

New patient portals launched, but lots more needed

Alex LambertSAULT STE. MARIE, Ont. – The Group Health Centre in Sault Ste. Marie, Ont., has joined the ranks of healthcare organizations offering a patient portal with secure access to test results and much more.

The Group Health Centre has launched myCARE, a secure online patient portal that provides patients with the ability to send messages to their healthcare team, request prescription renewals, manage appointments, and review lab test results online.

A survey of the more than 1,500 patients who were involved in the pilot phase reported that:
• 99 percent of patients surveyed would recommend myCARE to a friend or family member
• 97 percent agree that myCARE is user-friendly
• 93 percent agree it was easy to register
• 90 percent agree it’s easy to use

Alex Lambert (pictured), CEO of Group Health Centre, is confident that the launch of myCARE will help improve access to care and advice for patients.

“We believe healthcare is most effective when patients are engaged,” he said. “myCARE offers patients a number of unprecedented options for access, information, and communication. This kind of patient engagement leads to better outcomes for everyone involved.”

Michael Green, president and CEO of Canada Health Infoway, wants to maintain the momentum.

“While Canadians are ready for e-booking and viewing lab results online, only 6 to 10 percent have access now,” added Green. “The potential to enhance Canadians’ patient experience by improving care and reducing the amount of time required to renew prescriptions, book appointments and manage illness has never been greater than it is today.”

That view is echoed by leading Canadian health care organizations who have established Digital Health Week (November 16 – 22, 2015) to recognize how digital health is transforming care and helping to improve delivery of care across the country.
Think digital health isn’t making a difference? Think again. Visit

Thursday, October 8, 2015

CBC - Keeping Canada Alive website design & programming

The navigation web programming & design is excellent for this CBC project.

I looked at the Page Source for the coding trying to see if I could identify how they designed it. I am still not sure. I missed the ajax boat in programming utility and so I am not sure how that programming forms the navigation circle, if at all. Some of the navigation circle might be all done in CSS, maybe what they call "CBCcarousel":
Then I found out that "carousel" is actually a CSS class for design < here >.

It reminded me of an old style of web page design using photoshop image over layers.  The circle mouse over links to entire video documentaries is very useable. CBC may be selling off their buildings and laying off employees but at least they know how to deliver digital information. It could even be flash scripting? I've really not kept up with that either.

I think web design and programming for healthcare sites is part of a study of Health Informatics. We may recall the fiasco of the Obamacare website that had usability and server crashing issues.  For that matter, any electronic medical record system is first and foremost a web design application that must prioritize usability.

Speaking of Usability I have been trying to read through Steve Krug's "Rocket Surgery Made Easy: The Do-It-Yourself Guide to Finding and Fixing Usability Problems." Krug is right - he is not a book writer. Interesting layout for a book though.

The episodes for the CBC series don't appear to have one dedicated to an ehealth contextual scenario. I think that is because ehealth is usually kind of implicated throughout many aspects of healthcare, and not an all star focus?

Anyway, having watched a half dozen or so episodes, I am finding the whole thing quite an awesome educational trip! Here is a short clip intro to the project: